Contributors S. Prinja: Developed the model, interpreted the results and wrote the manuscript. PB: Contributed to development of the model,
reviewed literature and performed sensitivity analysis. RK, SMM, MK, S.Panda and IG: Contributed to conceptualisation of the
model, results interpretation, reviewed and revised the manuscript. SR and SC: Reviewed literature for estimating parameters
and reviewed the manuscript. All authors approved the final version of manuscript being submitted to the journal for publication.

Accepted 13 February 2011

Published Online First 29 March 2011

Abstract

Objective To ascertain the cost effectiveness of targeted interventions for female sex workers (FSW) under the National AIDS Control
Programme in India.

Methods A compartmental mathematical Markov state model was used over a 20-year time horizon (1995–2015) to estimate the cost effectiveness
of FSW targeted interventions, with a health system perspective. The incremental costs and effects of FSW targeted interventions
were compared against a baseline scenario of mass media for the general population alone. The incremental cost-effectiveness
ratio was computed at a 3% discount rate using HIV infections averted and disability-adjusted life-years (DALY) as benefit
measures. It was assumed that the transmission of the HIV virus moves from a high-risk group (FSW) to the client population
and finally to the general population (partners of clients).

Result Targeted interventions for FSW result in a reduction of 47% (1.6 million) prevalent and 36% (2.7 million) cumulative HIV
cases, respectively, in 2015. Adult HIV prevalence in India, with and without (mass media only) FSW interventions, would be
0.25% and 0.48% in 2015. Indian government and development partners spend an average US$104 (INR4680) per HIV infection averted
and US$10.7 (INR483) per DALY averted. Discounting at 3%, FSW targeted interventions cost US$105.5 (INR4748) and US$10.9 (INR490)
per HIV case and DALY averted, respectively.

Conclusion At the current gross domestic product in India, targeted intervention is a cost-effective strategy for HIV prevention in
India.